High Proportion Of Ethnic Minorities Research Articles

Clinical and genetic characterization of pediatric patients with Wilson's disease from Yunnan province where ethnic minorities gather.

Background: Wilson's disease (WD) is an autosomal recessive disease that is caused by mutations in the ATP7B (a copper-transporting P-type ATPase) gene. The disease has a low prevalence and is characterized by a copper metabolism disorder. However, various characteristics of the disease are determined by race and geographic region. We aimed to discover novel ATP7B mutations in pediatric patients with WD from Yunnan province, where there is a high proportion of ethnic minorities. We also performed a comprehensive analysis of ATP7B mutations in the different ethnic groups found in Southwest China. Methods: We recruited 45 patients who had been clinically diagnosed with WD, from 44 unrelated families. Routine clinical examinations and laboratory evaluations were performed and details of age, gender, ethnic group and symptoms at onset were collected. Direct sequencing of the ATP7B gene was performed in 39 of the 45 patients and their families. Results: In this study, participants came from seven different ethnic groups in China: Han, Bai, Dai, Zhuang, Yi, Hui and Jingpo. Three out of ten patients from ethnic minorities presented with elevated transaminases, when compared to the majority of the Han patients. Forty distinct mutations (28 missense, six splicing, three non-sense, two frameshift and one mutation of uncertain significance) were identified in the 39 patients with WD. Four of the mutations were novel and the most frequent mutation was c.2333G > T (p.R778L, allelic frequency: 15.38%). Using the phenotype-genotype correlation analysis, patients from ethnic minorities were shown to be more likely to have homozygous mutations (p = 0.035) than Han patients. The patients who carried the c.2310C > G mutation had lower serum ceruloplasmin levels (p = 0.012). In patients with heterozygous mutations, c.3809A > G was significantly associated with ethnic minorities (p = 0.042). The frequency of a protein-truncating variant (PTV) in Han patients was 34.38% (11/32), while we did not find PTV in patients from ethnic minorities. Conclusion: This study revealed genetic defects in 39 pediatric patients with WD from Yunnan province. Four novel mutations were identified and have enriched the WD database. We characterized the genotypes and phenotypes in different minorities, which will enhance the current knowledge on the population genetics of WD in China.

PSUN296 Impact of Diabetes Mellitus on Outcomes of Hospitalizations for SIADH

Abstract Introduction Diabetes mellitus (DM) is known to cause hyponatremia via multiple mechanisms and is often a confounder in the diagnosis of the syndrome of inappropriate anti-diuretic hormone secretion (SIADH). However, not much is known about the prevalence of DM in patients with SIADH or the effect it has on outcomes of hospitalizations for SIADH. Method: Data was extracted from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). We excluded hospitalizations of patients less than 18 years. This cohort was divided based on the secondary diagnosis of diabetes mellitus (DM). We compared inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), and acute pulmonary edema (PE) between the subgroups. Adjustments were made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value < 0.05. Results In 2019, there were 39,110 hospitalizations with SIADH as the reason for the admission. Comorbid DM was prevalent in 25.4% of these admissions. A higher proportion of hospitalizations involved females, with no significant difference between both cohorts (62.3 vs 60.1%, p=0.084). Patients with DM had a higher mean age (73.3±12 vs 72.4±13.8 years, p=0.005), a higher proportion of CCI >2, and a higher proportion of ethnic minorities. In patients with SIADH, DM was associated with no mortality difference (1.2% vs 0.9%, p=0.317) and no difference in LOS (4.9 vs 5.1 days, p=0.328) despite increased THC (10,873 vs 10,641 US$, p =0.03). Comorbid DM was associated with lower odds of AMI (0.4 vs 0.8%, aOR: 0.315, p=0.002), PE (0.15 vs 0.4%, aOR: 0.22, p=0.012) and ARF (6.8% vs 7.5%, aOR: 0.77, p=0.016), higher odds of AKI (15.9 vs 10.7, aOR: 1.23, p=0.008), with no significant difference in odds of septic shock or CVA. Conclusions Comorbid DM was associated with no difference in mortality or LOS despite an association with increased THC and AKI in hospitalizations of patients with SIADH. Notably, DM also appeared to lower the odds of AMI, PE, and ARF in this cohort of patients. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

RF32 | PSUN50 Hypertriglyceridemia as an Independent Risk Factor on Outcomes of Admissions for SIADH

Abstract Introduction The syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) is one of the most significant causes of potentially life-threatening hyponatremia. Hypertriglyceridemia (HTG), on the other hand, is one of the few disorders that spuriously reduce sodium levels and should be ruled out in the evaluation of patients with hyponatremia. Very scant literature exists on the coexistence of both conditions, and even less literature compares outcomes in patients with concomitant SIADH and HTG. Method We extracted data from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years were excluded. We then sub-divided the cohort based on the presence/absence of a secondary diagnosis of HTG. Outcomes compared include inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of comorbid septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), and acute pulmonary edema (PE) between the subgroups. An adjustment was made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value < 0.05. Results There were 39,110 hospitalizations involving patients with SIADH as the reason for the admission in 2019. Of these hospitalizations, 41.8% had comorbid HTG. A higher proportion of SIADH hospitalizations involved females, with no significant difference between both cohorts (61 vs 62.7%, p=0.119). Patients with HTG had a higher mean age (75.8±11.1 vs 70.4±14.4 years, p<0.001), a higher proportion of CCI >2, and a higher proportion of ethnic minorities compared to patients without HTG. Hospitalizations for SIADH with comorbid HTG were associated with lower adjusted odds ratio (aOR) for mortality (0.7 vs 1.4% in patients with HTG, aOR: 0.42, p<0.001), reduced LOS (4.9 vs 5 days, p=0.002), and reduced THC (10,263 vs 11,013 US$, p=0.005). There was no difference in the odds of comorbid septic shock, CVA, AMI, PE, ARF or AKI. Conclusions Interestingly, comorbid HTG lowered odds of mortality, LOS, and THC amongst patients hospitalized for SIADH. More studies should be carried out to investigate this rather paradoxical relationship with a view to defining a better understanding and devising more therapeutic strategies for both conditions. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:48 p.m. - 12:53 p.m.

Association of environmental and socioeconomic indicators with serious mental illness diagnoses identified from general practitioner practice data in England: A spatial Bayesian modelling study.

BackgroundThe evidence is sparse regarding the associations between serious mental illnesses (SMIs) prevalence and environmental factors in adulthood as well as the geographic distribution and variability of these associations. In this study, we evaluated the association between availability and proximity of green and blue space with SMI prevalence in England as a whole and in its major conurbations (Greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle).Methods and findingsWe carried out a retrospective analysis of routinely collected adult population (≥18 years) data at General Practitioner Practice (GPP) level. We used data from the Quality and Outcomes Framework (QOF) on the prevalence of a diagnosis of SMI (schizophrenia, bipolar affective disorder and other psychoses, and other patients on lithium therapy) at the level of GPP over the financial year April 2014 to March 2018. The number of GPPs included ranged between 7,492 (April 2017 to March 2018) to 7,997 (April 2014 to March 2015) and the number of patients ranged from 56,413,719 (April 2014 to March 2015) to 58,270,354 (April 2017 to March 2018). Data at GPP level were converted to the geographic hierarchy unit Lower Layer Super Output Area (LSOA) level for analysis. LSOAs are a geographic unit for reporting small area statistics and have an average population of around 1,500 people. We employed a Bayesian spatial regression model to explore the association of SMI prevalence in England and its major conurbations (greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle) with environmental characteristics (green and blue space, flood risk areas, and air and noise pollution) and socioeconomic characteristics (age, ethnicity, and index of multiple deprivation (IMD)). We incorporated spatial random effects in our modelling to account for variation at multiple scales.Across England, the environmental characteristics associated with higher SMI prevalence at LSOA level were distance to public green space with a lake (prevalence ratio [95% credible interval]): 1.002 [1.001 to 1.003]), annual mean concentration of PM2.5 (1.014 [1.01 to 1.019]), and closeness to roads with noise levels above 75 dB (0.993 [0.992 to 0.995]). Higher SMI prevalence was also associated with a higher percentage of people above 24 years old (1.002 [1.002 to 1.003]), a higher percentage of ethnic minorities (1.002 [1.001 to 1.002]), and more deprived areas.Mean SMI prevalence at LSOA level in major conurbations mirrored the national associations with a few exceptions. In Birmingham, higher average SMI prevalence at LSOA level was positively associated with proximity to an urban green space with a lake (0.992 [0.99 to 0.998]). In Liverpool and Manchester, lower SMI prevalence was positively associated with road traffic noise ≥75 dB (1.012 [1.003 to 1.022]). In Birmingham, Liverpool, and Manchester, there was a positive association of SMI prevalence with distance to flood zone 3 (land within flood zone 3 has ≥1% chance of flooding annually from rivers or ≥0.5% chance of flooding annually from the sea, when flood defences are ignored): Birmingham: 1.012 [1.000 to 1.023]; Liverpool and Manchester: 1.016 [1.006 to 1.026]. In contrast, in Leeds, there was a negative association between SMI prevalence and distance to flood zone 3 (0.959 [0.944 to 0.975]). A limitation of this study was because we used a cross-sectional approach, we are unable to make causal inferences about our findings or investigate the temporal relationship between outcome and risk factors. Another limitation was that individuals who are exclusively treated under specialist mental health care and not seen in primary care at all were not included in this analysis.ConclusionsOur study provides further evidence on the significance of socioeconomic associations in patterns of SMI but emphasises the additional importance of considering environmental characteristics alongside socioeconomic variables in understanding these patterns. In this study, we did not observe a significant association between green space and SMI prevalence, but we did identify an apparent association between green spaces with a lake and SMI prevalence. Deprivation, higher concentrations of air pollution, and higher proportion of ethnic minorities were associated with higher SMI prevalence, supporting a social-ecological approach to public health prevention. It also provides evidence of the significance of spatial analysis in revealing the importance of place and context in influencing area-based patterns of SMI.

Cannabis use among the drug users with compulsory detained detoxification treatment in China

To explore the epidemic situation of cannabis use among drug users with compulsory detained detoxification treatment in China. Using the data from the Drug Abuse Population Estimation in the Key Cities of the Ministry of Public Security, we analyzed the sociodemographic characteristics and substance use of cannabis abusers with compulsory detained detoxification treatment in 55 provincial capital cities and key cities of China. Chi-square test, Fisher exact test and Kruskal-Wallis rank sum test were used to compare the prevalence of cannabis, heroin, synthetic and mixed drug use among patients with detoxification treatment, as well as the differences in polydrug use and areas among cannabis users. In the study, 25 366 drug users with compulsory detained detoxification treatment were recruited, of whom 2.2% (546/25 366) used cannabis in the previous year before the treatment. The proportion of males was 83.5%, and the proportion of ethnic minorities was 41.0%. Those who received junior high school education or above accounted for 30.8%, and the unemployed accounted for 44.1%. The average age was (33.3±8.2) years, the average age of beginning drug use was (24.8±7.7) years, and the average duration between the first drug abuse and first detoxification treatment was (5.4±4.6) years. The prevalence of cannabis use was higher among those drug users who were 35-year-old and younger, ethnic minorities, employees and residents in Xinjiang. Of the cannabis users, 91.4% used polydrug, 13.6% combined with heroin alone, 42.1% combined with synthetic drugs alone and 35.7% combined with both of heroin and synthetic drugs. Of the cannabis users, 49.6% came from 3 regions: Xinjiang Uygur Autonomous Region, Jiangsu Province and Shanghai City. The cannabis users in Xinjiang had a high proportion of ethnic minorities who received junior high school education and below. Moreover, 79.6% of them combined cannabis use with heroin. The cannabis users in Jiangsu, Zhejiang and Shanghai areas had a higher proportion of ethnic Han who received better education (high school and above). Moreover, 92.7% of them combined cannabis use with methamphe-tamine. The prevalence of cannabis use among the population with compulsory detained detoxification treatment is higher than that among drug users under surveillance, but there are obvious regional cluster effect and high possibility of polydrug abuse. Thus, it's important to strengthen the monitoring of cannabis use, to increase the control of cannabis and to formulate China's anti-cannabis policy among different population.

Chinese trends in adolescent marriage and fertility between 1990 and 2015: a systematic synthesis of national and subnational population data

Early marriage and fertility are major social determinants of health and wellbeing. Rapid shifts in the past three decades, including a rise in sexual activity in unmarried adolescents, a large population of young migrant workers, and a high proportion of males relative to females, have the potential to alter patterns of reproductive health in Chinese adolescents and young women. We aimed to establish long-term trends of marriage and fertility for girls and women aged 15-24 years in China. We did a longitudinal study in which we extracted aggregated data for marriage and childbearing status for Chinese girls and women aged 15-24 years from the Chinese National Population Census (in 1990, 2000, and 2010) and the Chinese 1% National Population Sample Survey (in 1995, 2005, and 2015). The census included all individuals with Chinese nationality who resided in China when the survey was done. For the 1% sample survey, communities or villages were randomly selected and all residents with Chinese nationality in the selected communities or villages were included. In all censuses and sample surveys, forms that included information on basic demographic characteristics, education, marriage, and fertility were completed and verified by the census enumerators at the household residence, based on responses provided by the householder or another adult in the household. We calculated the ever-married rate and age-specific fertility rate (ASFR) for all included individuals. We built multivariate random-effects generalised least squares regression models on panel data to test whether marriage or fertility rate was associated with education level, sex ratio, and the proportion of the population who are an ethnic minority in a province. The ever-married rate for those aged 15-19 years decreased from 4·7% in 1990 to 1·2% (95% CI 1·2-1·3) in 2000, but rebounded to 2·4% (2·4-2·5) in 2015. The ASFR for this age group decreased from 22·0 births per 1000 individuals in 1990 to 6·0 (5·9-6·0) births per 1000 in 2000, and rebounded to 9·2 (8·9-9·4) births per 1000 in 2015. The rebound was found in most provinces. In women aged 20-24 years, the ever-married rate generally declined from 58·6% in 1990 to 25·5% (95% CI 25·4-25·6) in 2015, and the ASFR decreased from 198·8 births per 1000 in 1990 to 55·0 (54·5-55·5) births per 1000 in 2015. In 2015, the ever-married rate and ASFR for girls and women in rural areas aged 15-19 years were three-times higher than those of their urban counterparts (3·8% [95% CI 3·7-3·9] vs 1·1% [1·1-1·1] for the ever-married rate and 15·4 [14·9-15·9] vs 4·1 [3·9-4·3] births per 1000 for the ASFR). There were large disparities in ever-married rate across individuals of different education levels, with increases in the ever-married rate of 15-19-year-olds not attending senior high school between 2000 and 2010. Those aged 15-19 years were more likely to be married or give birth in the western provinces. Education held a protective association against adolescent childbearing, whereas a high ratio of males to females and a high proportion of ethnic minorities were associated with greater risk. Although China's total fertility rate remains far less than replacement, after a period of steady decline, there has been a rebound in adolescent marriage and childbearing in the past decade. A range of adolescent-targeted strategies will be needed across provinces, including scaling up comprehensive sex education, ensuring that girls continue in school, and providing adequate reproductive health services, which specifically meet the needs for modern contraception in sexually active unmarried girls. Humanities and Social Sciences Planning Fund Project, Sports and Health Special Project of Education and Scientific Research, and China Scholarship Council.

Vulnerability assessment of households to flash floods and landslides in the poor upland regions of Vietnam

Increased frequency and intensity of flash floods and landslides in the Northern Mountainous Regions of Vietnam represent the most damaging hazards to the production activities and livelihoods of rural households, which are heavily reliant on agriculture. Assessing households’ vulnerability therefore becomes critical and urgent to help policy-makers in Vietnam in facilitating the implementation of adaptation strategies for households living in this area. Thus, this paper employed the Household Vulnerability Index method along with the qualitative data analysis to evaluate the vulnerability level of smallholder farmers under the effect of these hazards. Data was collected from 405 households in three communes of Yen Bai province, one of the poorest provinces in the Northern Mountainous Regions of Vietnam with a high proportion of ethnic minorities who have extremely low incomes and education levels. Food and fresh water quality and security are also relatively low in this region. The empirical results indicate that ethnicity, diversified sources of income, organizational membership, health insurance, food security, land tenure documentation, water resources, and locational dimensions are the key factors affecting the vulnerability of farmers under the impacts of flash floods and landslides. Results also suggest that the livelihoods of farmers in the Dai Son commune are the most vulnerable to these natural hazards identified by the Social Network, Socio-Demographic Profile, and Water component factors. We subsequently identify and prioritize measures to ensure sustainable livelihoods for local farmers through practices, such as improving people’s literacy, enhancing production systems, and strengthening natural resource management strategies.

Inequalities in exposure to the air pollutants PM2.5 and NO2 in Australia

Vulnerable subpopulations may be exposed to higher levels of outdoor air pollution than the rest of the population. Due to the potential for this to exacerbate their existing health burden, concerns about disparities in subpopulations’ air pollution exposure have motivated international public health researchers to examine this topic. In Australia, such research is lacking to date, despite heterogeneity in air pollution at multiple spatial scales across the continent. This study aimed to investigate disparities in exposure to two health-relevant outdoor air pollutants: particulate matter <2.5 μm (PM2.5) and nitrogen dioxide (NO2). We used national land-use regression models to estimate annual average concentrations of PM2.5 and NO2, and area-level census data on ethnicity, age and socio-economic status (SES) to calculate the bivariate associations between each census-derived variable with the concentration of air pollutants. We also used multivariable models including specific measures of SES as covariates to assess to what extent associations were explained by SES. Associations were calculated separately for rural and urban areas using generalised additive models which accounted for spatial autocorrelation. Bivariate results showed significant nonlinear associations (p < 0.001) between vulnerable subpopulations and pollutant concentration. These associations suggested that areas with greater socio-economic disadvantage, a higher proportion of ethnic minorities, and elderly people are exposed to higher concentrations of PM2.5 and NO2, although differences in the magnitude of exposure were small overall. Our multivariable models showed that the associations between ethnic minorities and pollutant concentration appear to be substantially affected by area-level SES. Our results suggested that these vulnerable subpopulations are inequitably exposed to PM2.5 and NO2. While the magnitude of differences in exposure were generally small, the predicted differences in exposure among vulnerable subpopulations could contribute to a potentially avertable health burden at a population-level.

Gene-environment interaction between an IL4R variant and school endotoxin exposure contributes to asthma symptoms in inner-city children

Gene-environment interaction between an IL4R variant and school endotoxin exposure contributes to asthma symptoms in inner-city children

Clinical characteristics and outcomes on discharge of women admitted to a Medium Secure Unit over a 4-year period

There are limited data on women in Medium Secure settings. This study aimed to address this by assessing the characteristics of 45 consecutive admissions to the female ward of a Medium Secure Unit in the United Kingdom over a four-year period. Data on demographics, clinical outcomes and from HONOS-Secure/HONOS and HCR-20 assessments were prospectively collected. Psychiatric diagnoses were recorded using ICD-10 criteria. Data on quality of life from WHO-QoL-BREF surveys were analysed. There was a high proportion of ethnic minorities (57.8%), high rates of childhood and adult abuse and low socioeconomic status. 62.2% of the patients had schizophrenia, 57.8% had multiple diagnoses. The median length of stay at discharge was 465.5days. There were statistically significant reductions in rates of self-harm and HoNOS-Secure/HoNOS and HCR-20 scores following intervention. Scores on WHO-QoL-BREF compared favourably to a large-scale sample with mental health difficulties. Many characteristics of this sample were comparable to samples from similar populations. However the particularly high proportion of ethnic minorities suggested that the profile of our patients differs from nationwide samples. Intervention by our service was associated with reduced self-harm and improvements in well-defined clinical outcomes and quality of life measures using validated scales.

Measuring SES in immigration countries: ‘blind spot’ regarding specific resources and liabilities of migrants? Cross-sectional study

Review of secondary data sources using information from web pages, publications and personal contacts. Cohort identification was based on relevant web pages (i. a. birthcohorts.net, chicosproject.eu). Birth cohorts were included if they were located in a European country. Publically available material of each birth cohort was screened for information on the inclusion of ethnic minority groups. To obtain more detailed information, birth cohorts were contacted individually between November 2012 and April 2013. Results Seventy-four European birth cohorts were identified, totaling more than 550,000 children in 21 different European countries. Of these, 55 (74%) birth cohorts collected information on ethnicity and 25 (34%) stated the percentage of ethnic minorities among study participants. Twelve studies (16%) could provide information stratified by different ethnic groups in their study and five studies (7%) used information on ethnicity for comparative analyses. In 51 (69%) of the birth cohorts participation of ethnic minorities was limited to persons who had adequate language skills of the country in which the study took place, which limited the ability of ethnic minorities to take part in the study. Conclusions The majority of birth cohorts assessed participants’ ethnic background; however, information on the proportion of ethnic groups and use of ethnicity for comparative analyses were scarce. Birth cohorts from countries with a high proportion of ethnic minorities often enrolled a comparatively low proportion of ethnic groups. More birth cohort studies are needed that explicitly include ethnic minority groups, actively enable participation of ethnic minority groups and conduct comparative analyses. Key messages In European birth cohorts, ethnicity is often measured, but seldom reported or used for stratified analyses. Birth cohorts should actively enable participation of ethnic minority groups and conduct comparative analyses.

Neighbourhood food and physical activity environments in England, UK: does ethnic density matter?

BackgroundIn England, obesity is more common in some ethnic minority groups than in Whites. This study examines the relationship between ethnic concentration and access to fast food outlets, supermarkets and physical activity facilities.MethodsData on ethnic concentration, fast food outlets, supermarkets and physical activity facilities were obtained at the lower super output area (LSOA) (population average of 1500). Poisson multilevel modelling was used to examine the association between own ethnic concentration and facilities, adjusted for area deprivation, urbanicity, population size and clustering of LSOAs within local authority areas.ResultsThere was a higher proportion of ethnic minorities residing in areas classified as most deprived. Fast food outlets and supermarkets were more common and outdoor physical activity facilities were less common in most than least deprived areas. A gradient was not observed for the relationship between indoor physical activity facilities and area deprivation quintiles. In contrast to White British, increasing ethnic minority concentration was associated with increasing rates of fast food outlets. Rate ratios comparing rates of fast food outlets in high with those in low level of ethnic concentration ranged between 1.28, 95% confidence interval 1.06-1.55 (Bangladeshi) and 2.62, 1.46-4.70 (Chinese). Similar to White British, however, increasing ethnic minority concentration was associated with increasing rate of supermarkets and indoor physical activity facilities. Outdoor physical activity facilities were less likely to be in high than low ethnic concentration areas for some minority groups.ConclusionsOverall, ethnic minority concentration was associated with a mixture of both advantages and disadvantages in the provision of food outlets and physical activity facilities. These issues might contribute to ethnic differences in food choices and engagement in physical activity.

Retracted: Prevalence and Burden of Headache Disorders: A Comparative Regional Study in China

Background.— Since the early 1990s, no study has been undertaken examining the prevalence and burden of headache disorders in China.Objective.— We conducted a one‐year survey on the prevalence and burden of primary headache in the Chinese provinces of Guangdong and Guangxi. Our study also evaluated the factors behind similarities and differences affecting prevalence in the 2 regions of study.Methods.— Random samples of 372 local residents in Guangdong and 182 local residents in Guangxi aged 18‐65 years were invited to a face‐to‐face interview.Results.— The one‐year prevalence of primary headache was 22.6% (84/372) in Guangdong and 41.2% (75/182) in Guangxi. The prevalence of migraine (14.3%, n = 26) in Guangxi was higher than prevalence of migraine (8.3%, n = 31) in Guangdong (P = .03). The ratio of headache cost and household income was 2.1% in Guangdong and 3.7% in Guangxi, the ratio in Guangdong was less than that in Guangxi (P = .001). The diagnostic confirmation rate of migraine was low. No migraineur used triptans drugs to treat migraine in either region.Conclusion.— Migraine prevalence was higher in the lower‐income region that also contains a higher proportion of ethnic minorities. Although there was no difference of headache cost between the 2 regions, the headache populations in the lower‐income region would relatively suffer a greater financial burden if taking the economic differences between the 2 regions into account. The improvement of diagnostic and therapeutic levels for the treatment of headache, especially migraine, in the 2 regions may be a matter of urgency.

Medically Unexplained Symptoms Presenting at Secondary Care—A Comparison of White Europeans and People of South Asian Ethnicity

To assess whether, among new out-patients at secondary care medical clinics, people of South Asian origin have a higher proportion of medically unexplained symptoms, and receive different care compared to white Europeans. A retrospective case note study was performed in a district general hospital with a high proportion of ethnic minorities in the local population. We examined the notes of 100 people each of South Asian and white European origin who were in the 20-39 years age range and attending as new medical out-patients. We recorded the presenting symptoms, investigation results, and management plan, and from this we classified them as either explained by recognized organic disease or medically unexplained. We also recorded the number of investigations and whether psychosocial factors were mentioned in the letter to the referring doctor. Complete data were available for 93 people of South Asian origin and 98 white Europeans. The proportion of each who had medically unexplained symptoms was 52% and 49% respectively. The mean number (SD) of investigations in each was 1.8 (1.5) and 1.7 (1.6). Psychosocial factors were mentioned in correspondence of 42% and 45% respectively. The prevalence of medically unexplained symptoms, in this UK clinic, is similar among younger adults of South Asian and white European origin. South Asians undergo similar investigation and psychosocial inquiry to their white counterparts, suggesting that younger South Asians are managed similarly to white Europeans with respect to this aspect of medical care.

Socioeconomic Deprivation and Extended Hospitalization in Severe Mental Disorder: A Two-Year Follow-Up Study

Socioeconomic Deprivation and Extended Hospitalization in Severe Mental Disorder: A Two-Year Follow-Up Study

Risk Factor Associations With the Presence of a Lipid Core in Carotid Plaque of Asymptomatic Individuals Using High-Resolution MRI

Atheroma vulnerability to rupture is increased in the presence of a large lipid core. Factors associated with a lipid core in the general population have not been studied. The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of individuals free of clinical cardiovascular disease designed to include a high proportion of ethnic minorities. We selected MESA participants from the top 15th percentile of maximum carotid intima media thickness by ultrasound and acquired high-resolution black blood MRI images through their carotid plaque before and after the intravenous administration of gadodiamide (0.1 mmol/kg). Lumen and outer wall contours were defined using semiautomated analysis software. We analyzed only plaques with a maximum thickness >or=1.5 mm by MRI (n=214) and assessed cross-sectional risk factor associations with lipid core presence by multivariable logistic regression. A lipid core was present in 151 (71%) of the plaques. After controlling for age, ethnicity, sex, maximum arterial wall thickness, hypertension, cigarette smoking, diabetes, and C-reactive protein, compared with participants in the lowest tertile of total plasma cholesterol, the ORs of having a lipid core for participants in the middle and highest tertiles were 2.76 (95% CI: 1.01 to 7.51) and 4.63 (95% CI: 1.56 to 13.75), respectively. None of the other risk factors was associated with lipid core. In persons with thickened carotid walls, plasma total cholesterol, but not other established coronary heart disease risk factors, is strongly associated with lipid core presence by MRI. High total cholesterol may be associated with rupture proneness of atherosclerotic lesions in the general population.

Differences in Characteristics of US Hematopoietic Stem Cell Transplantation Centers by Proportion of Racial or Ethnic Minorities

Racial or ethnic minorities with leukemia who receive HLA-identical sibling hematopoietic stem cell transplants (HSCTs) are reported to have worse survival when compared with whites. Characteristics of US HSCT centers according to the proportion of ethnic minorities who undergo transplantation were compared to explore systematic differences among centers; the association with 100-day mortality was evaluated to determine whether center factors may explain the observed discrepant survival among ethnic minorities. One hundred sixteen US transplantation centers that performed HLA-identical sibling transplantations for leukemia were analyzed. We compared physician and health care provider staffing, transplantation unit procedure and resources, and medical center organization according to the volume procedure ratio of ethnic minorities who underwent transplantation and also according to the ratio of Hispanics who underwent transplantation. Centers that performed transplantation in a higher proportion of ethnic minorities were more likely to perform fewer transplantations per year, to have fewer devoted transplant beds, to be in an urban setting, to have a lower physician to patient volume ratio, and to follow up survivors 1 year after transplantation. Centers that performed transplantation in a higher proportion of Hispanics were more likely to perform fewer transplantations per year and to have fewer devoted transplantation beds, were less likely to perform outpatient transplantations, were more likely to be in an urban setting, and were less likely to have posttransplantation immunization protocols. Observed differences in center factors were not associated with 100-day mortality after adjustment for disease severity. Our results suggest that the inferior survival reported in ethnic minorities after HSCT may not be readily explained by center effects.

Ethnicity study and non-selective screening for haemoglobinopathies in the antenatal population of central Manchester.

The objective of this study was to determine the frequency of ethnic groups within the antenatal population in central Manchester and thereby ensure that the haemoglobinopathy service was targeting the correct population and their needs. Ethnic data collection records of 6718 patients were analysed over a 7 month period. Of these 62.3% stated that they were White, 13.2% Asian, 7.9% Black, 3.8% Chinese or 'other ethnic groups' and 12.7% gave no information about their ethnic background. A subset of 1144 patients were screened for haemoglobinopathies over a 1 month period. The incidence of haemoglobinopathies within the screened population was 2.62%, and comprised 0.69% beta thalassaemia trait, 1.22% sickle cell trait, 0.43% haemoglobin C trait and 0.26% haemoglobin D trait. The total incidence of haemoglobinopathies was highest within the Black population (18.2%), followed by the no information group (5.6%), Asian (3.35%) and white (0.26%). The high proportion of ethnic minorities and the significant carrier frequency in the no information group, support our view that non-selective screening should be offered to the antenatal population of central Manchester.

Population need for renal replacement therapy in Thames regions: ethnic dimension

To determine the use of renal replacement therapy by ethnic origin and to ascertain the variation in provision of such therapy and to relate this to the distribution of ethnic minority populations. Analysis of retrospective and cross sectional data from 19 renal units. All four Thames regional health authorities. Patients resident in the Thames regions who were accepted as new patients for renal replacement therapy during 1991 and 1992 and the patients who were already undergoing such treatment between December 1992 and April 1993. Rates of acceptance for and prevalence of renal replacement therapy among white, black, and Asian people. The average annual acceptance rates per million in 1991-2 were 61 for white people, 175 for black people, and 178 for Asians, and the prevalences per million were 351, 918, and 957 respectively. The relative risks increased with age. A threefold increase in the acceptance rate occurred in people aged under 55 in both the black and Asian populations, suggesting that the higher rates are probably not due to factors related to access alone. Treatment rates varied considerably among districts, reflecting both the distribution of ethnic minority populations and access to services. Black and Asian people receive and have a greater need for renal replacement therapy, and the need will increase as these populations age. These findings have important implications for the provision of renal services in districts with a high proportion of ethnic minorities and for the management of diabetes mellitus and hypertension, two important causes of end stage renal failure in these populations.

School meals, school milk and height of primary school children in England and Scotland in the eighties.

In a nutritional surveillance system of primary school children in England and Scotland we assessed the possible effects on height gain of changes in school meals and school milk policies following the 1980 Education Act (No. 2). Mean height and height gain were estimated separately for English and Scottish samples from 1982 to 1984, and for a selective sample of inner city areas with a high proportion of ethnic minorities from 1983 to 1985 in children from 5.00 to 9.99 years. Children receiving free school meals were smaller than children paying for school meals or receiving a meal prepared elsewhere, while children receiving free school milk were of similar stature to other children in the study. The rate of growth was assessed in children receiving school meals or lunches prepared at home, and in those for whom arrangements changed during the study period; it was also assessed in those children for whom school milk was available, not available, or for whom the provision changed. No consistent association was found between provision of school meals or school milk and the rate of growth in the three samples studied when stratified according to poverty status and ethnic background. We conclude that this observational study does not provide any evidence that the current availability of school meals or school milk increases the rate of growth of primary school children in any social stratum.